Examination of a deep respiratory specimen (induced sputum or bronchoalveolar lavage) can be useful in a patient with an exacerbation of asthma.
Patient selection: A patient with asthma experiencing an exacerbation of symptoms.
Specimen: induced sputum or bronchoalveolar lavage (BAL). A regular sputum specimen may not reflect processes within the lung and may be mostly oropharyngeal fluids.
Parameters:
(1) level of white blood cells
(2) differential count of the white blood cells
Number of White Blood Cells
Differential Count
Possible Interpretation
low levels
eosinophils
stable asthma
increased
eosinophils
exacerbation of asthma, probably corticosteroid responsive
increased
neutrophils
possible infection underlying exacerbation; may respond poorly to corticosteroids
increased
hemosiderin laden macrophages
congestive heart failure
In the future analysis of a deep respiratory specimen for prostaglandins, cytokines or other biomarkers may provide additional insights into an exacerbation of asthma.
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